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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Myotonic dystrophy or Steinert's disease may be discovered during acute respiratory failure, sometimes caused by a general anaesthetic. It complicates chronic respiratory failure which is present in almost all cases, both restrictive and obstructive, the clinical signs of which progress with the myopathy. Apart from myotonic degeneration of the respiratory muscles, a hypoventilation syndrome of central origin has been described, but the etiology of this respiratory failure is dominated by repeated aspiration pneumonia favoured by constant dysphagia and passage of food into the trachea and poor cough reflex. One should attempt to correct this.
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PMID:[Myotonic dystrophy and acute respiratory insufficiency]. 19 96

Systemic lupus erythematosus with polymyositis and polyarthritis was diagnosed in a 7-year-old female Standard Poodle. Pertinent clinical signs included extreme muscular weakness, muscle wasting, atrial fibrillation, and dysphagia due to megaesophagus. Aspiration pneumonia secondary to the megaesophagus contributed to the death of the dog. Serum muscle enzyme activities were increased. Electromyographic findings included fibrillation potentials, positive sharp waves, increased insertional activity, and bizarre high-frequency repetitive potentials. Histopathologic findings in skeletal muscle included myofiber necrosis and phagocytosis; regeneration of myofibers; perivascular and interstitial infiltrations of macrophages, lymphocytes, and plasma cells; and type I and II myofiber degeneration and vacuolation.
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PMID:Polymyositis and polyarthritis associated with systemic lupus erythematosus in a dog. 83 Jun 33

This study was designed to determine whether swallow rehabilitation outcomes were affected by the type of evaluation procedure utilized by the clinician. The two evaluation techniques compared were the bedside examination and videofluoroscopy (the modified barium swallow). Ten institutions participated in this study, enrolling a total of 103 partial laryngectomized patients, 21 in the bedside arm and 82 in the videofluoroscopy arm. Data on recovery of oral intake were collected weekly. All patients received an X-ray study of swallow at 3 months after the operation. Mean time to oral intake of food was significantly lower in patients assessed with bedside examination. Overall swallow measures of transit times and swallow efficiencies after 3 months revealed significantly better function in the videofluoroscopy group. Results are discussed in terms of the visibility of swallow physiology with the two assessment techniques, the accuracy of therapy planning with the bedside examination versus videofluoroscopy and the ability of head and neck cancer patients to tolerate some aspiration without developing aspiration pneumonia.
Dysphagia 1992
PMID:Impact of the diagnostic procedure on outcome measures of swallowing rehabilitation in head and neck cancer patients. 142 31

Some elderly patients with chronic illness such as stroke, or Parkinsonism cannot take food orally because of dysphagia. In such cases, tube feeding can be used as a supplement to oral intake when malnutrition is present. This route allows for easier nursing care and decreases the frequency of aspiration pneumonia. Complications of tube feeding include nutrient deficiency states, pulmonary aspiration, gastrointestinal and metabolic disorders. We report two cases with complications of acute gastric ulcer which was thought to be induced with long-term tube feeding. Case 1 was a 61-year-old male patient with Parkinson's disease for ten years. L-DOPA had been administered with good control of his condition. However, his ability to swallow has deteriorated gradually. As he often suffered from aspiration pneumonia, nasogastric tube feeding was performed. After three years of tube feeding, he suddenly vomited much bloody material. He died from massive bleeding with acute gastric dilatation. Autopsy showed giant acute gastric ulcer covered with coagulated blood. UL3, 50 mm in maximum diameter, was observed in the middle portion of the greater curvature, where the top of tube probably came in contact with the gastric wall. Case 2 was an 83-year-old female patient with stroke and chronic heart failure. She had been hospitalized for about one year because of the intermittent deterioration of her cardiac condition. Furthermore, her inability to swallow increased during her hospitalization. She also suffered from aspiration pneumonia. Nasogastric tube feeding was performed to prevent aspiration pneumonia and malnutrition. She died of acute heart failure after twelve months. Autopsy revealed heart dilatation, old myocardial infarction and stroke. In addition, two acute gastric ulcers (UL3.10 and 30 mm in diameter) were recognized; one was in the upper portion of the greater curvature, the other in the lower portion of the greater curvature. The location of these gastric ulcers was unusual. Moreover, they coincided with location of top of the nasogastric tube. From these two cases, we conclude that in long-term tube feeding the tip of the tube often comes in contact with the gastric wall, and gastric ulcer could be produced by repeated mechanical stimulus of the wall. Reports of acute gastric ulcer induced by tube feeding have not been published previously. Therefore, we should pay much attention to this complication in the care of the elderly people with long-term tube feeding.
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PMID:[Long-term nasogastric feeding and complications of acute gastric ulcer in two elderly patients]. 143 62

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

A 6-month-old male infant with difficulty swallowing, recurrent aspiration pneumonia and failure to thrive was diagnosed with cricopharyngeal achalasia. Normal oral feeding and no further aspirations followed a single catheter balloon dilatation.
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PMID:Balloon dilatation of cricopharyngeal achalasia. 149 11

Aspiration is a common problem following stroke, resulting in feeding difficulties and aspiration pneumonia. Despite past studies using clinical assessments and computed tomographic (CT) scans of the head, the correlation of stroke location with aspiration remains unclear. Since brain magnetic resonance imaging is more sensitive than CT for many stroke types, we have correlated MRI lesions with aspiration in patients who have sustained a stroke. We selected patients with acute stroke who underwent brain MRI and a swallowing evaluation. Aspiration was present in 21 of 38 patients (55%). Patients with just small vessel infarcts had a significantly lower occurrence of aspiration (3 of 14, 21%) compared to those with both large- and small-vessel infarcts (15 of 20, 75%, p = 0.002). Multivariate analysis of several specific brain areas failed to identify a significant association between stroke location and the occurrence of aspiration. These findings suggest that patients who have experienced stroke should be individually evaluated for swallowing dysfunction regardless of stroke location or size, since even small-vessel strokes can be associated with aspiration in greater than 20% of cases.
Dysphagia 1992
PMID:Aspiration after stroke: lesion analysis by brain MRI. 149 61

Between 1969 and 1989, thirty-three patients were admitted for the treatment of a mid- or lower thoracic diverticulum and were investigated. Their mean age was 63 years. The predominant symptoms were dysphagia and regurgitations of, on average, 5.8 years' duration. Three patients had associated carcinoma and were excluded from the study. Three patients with mild complaints were managed medically and 27 surgically. Surgical treatment included, prior to 1979, simple diverticulectomy in 10 patients since 1970 diverticulectomy and myotomy through a right thoracic approach in one patient diverticulectomy, esophageal myotomy and fundoplication through a left thoracic approach in 10 patients and simple abdominal esophageal myotomy with fundoplication in 4 patients. In 2 patients, an esophagobronchial fistula was successfully treated. There were 3 postoperative deaths (2 suture line leakages and one massive aspiration pneumonia). Two patients had persistent dysphagia: one was reoperated on for a subsequent abdominal esophageal myotomy and the other one for severe reflux esophagitis following esophageal dilatations. Four patients had reflux esophagitis and two were reoperated on for a total duodenal diversion. The importance of the long esophageal myotomy extended on to the cardia through a left thoracotomy, and of a good antireflux procedure after the myotomy, in the treatment of thoracic esophageal diverticula is emphasized.
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PMID:Surgical management of esophageal thoracic diverticula. 163 87

We report a case of encephalitis in a 32-year-old woman who initially developed a schizophreniform disorder. The symptoms were further complicated by abnormal movements, dysphagia, progressive weight loss, and aspiration pneumonia. At necropsy, the lesion was noted in various parts of cerebrum and brainstem. Such unusual presentation in patient with encephalitis appears unique and has not been previously reported.
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PMID:Encephalitis presenting as schizophreniform disorder and dysphagia. 164 49

Tetanus remains a life-threatening disorder and its fulminating course always presents a challenge to the clinician. We retrospectively evaluated 56 patients with tetanus admitted to VGH-Taipei between 1971 and 1990. All of these patients with tetanus on admission showed typical features, with the most common initial complaints being lockjaw and dysphagia (82.6%). They were diagnosed on clinical identification rather than isolation of the causative agent. The laboratory tests were usually nonspecific and of limited value for diagnosis. Overall, 38 patients were seized with tetanus after an identified wound infection. The most common routes were puncture wound (28.3%) and abrasion wound (19.6%). The majority of patients became symptomatic within 10 days (56.5%) and the shorter interval reflected a more overwhelming course (p less than 0.05). Intravenous drug abusers and larger wounds had a poorer prognosis. The average mortality was 39.1% (18 out of 46 patients; male/female 12/6), with lack of statistical difference between sex and mortality (p greater than 0.5). The course of tetanus in the newborn and elderly was also more deadly (mortality rates of 83.3% and 55.6% respectively). Aspiration pneumonia and subsequent respiratory failure accounted for the most common cause (11 cases, 61.1%) of death. The mortality was still high (28.6%) from 1980-90 even with better supportive care and modern therapeutic equipment.
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PMID:Tetanus: 20 years of clinical experience. 165 80


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